RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-00514
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060413

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Basic Trainee, medically separated for “chronic pain, right knee, due to medial tibial plateau stress fracture,” with a disability rating of 10%.

CI CONTENTION: The CI contends his injury was misdiagnosed.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060313	VARD - 20060419	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Pain, Right Knee, due to Medial Tibial Plateau Stress Fracture	5099- 5003	10%	
Service Connection for Chronic Right Knee Pain due to Medial Tibial Plateau Stress
	5299-5262	10%	20060301	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Chronic Pain, Right Knee, due to Medial Tibial Plateau Stress Fracture.  According to service treatment records (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right knee pain began in July 2005 after a fall while negotiating the obstacle course in basic training.  A magnetic resonance imaging study of the right knee on 12 August 2005 revealed a nondisplaced fracture of the anteromedial tibial plateau with bone bruise of the medial and lateral femoral condyles.  There was no surgical indication, and conservative treatment did not result in improvement sufficient to allow unrestricted duty.  The MEB forwarded “chronic right knee pain status/post right medial tibial plateau stress fracture” for PEB adjudication.  

At the MEB examination (recorded on DD Forms 2807 and 2808) dated 9 January 2006, 3 months prior to separation, the CI reported the stress fracture causes chronic pain.  Physical exam noted painful right knee but no other abnormality.   The MEB NARSUM examination on 6 February 2006, 2 months prior to separation, noted complaints of severe right knee pain that prohibited running.  Physical examination showed an unremarkable general physical examination except for slight tenderness to palpation in the right medial knee joint line and along the patellar tendon.  There was no swelling and no neurovascular changes. Range of motion (ROM) testing revealed extension of 0 degrees (0 normal) and flexion to 110 degrees (140 normal) without pain.  The CI reported some "tightness" on full flexion.  Radiographic studies revealed a “healing medial tibial stress fracture and no other pathology.”

At the 1 March 2006 VA Compensation and Pension (C&P) evaluation, performed a month before separation, the CI reported localized sharp right knee pain that “comes and goes” throughout the day.  The CI reported at the time of pain he could function without medication.  Physical exam showed right knee tenderness of proximal tibial plateau, flexion to 140 degrees and 0 degree of extension.  ROM was not functionally limited by repetitive use, weakness, or coordination.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the right knee pain 10%, coded 5003 (Arthritis, degenerative (hypertrophic or osteoarthritis)), citing the US Army Physical Disability Agency (USAPDA) pain policy.  The VA rated the right knee pain 10% coded 5262 (Tibia and fibula, impairment of), based on the VA C&P examination a month before separation, citing evidence of a tibial fracture resulting in slight knee disability in the form of tenderness and mild restriction of flexion due to pain.  There was no limitation of motion which supported a rating under the diagnostic codes for limitation of flexion or extension (5260, 5261).  However, there was evidence of painful motion with functional loss supporting a 10% rating (based on §4.59, §4.40 and §4.45) as adjudicated by the PEB.  There was no evidence of malunion of the tibia that resulted in moderate knee or ankle disability that would support a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the right knee pain.  

BOARD FINDINGS:  In the matter of the right knee pain and IAW VASRD §4.71a, the Board recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150601, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

SAMR-RB						

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for 
XXXXXXXXXXXXXXXXXX, AR20160018737 (PD201500514)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF: 
(  ) DoD PDBR
(  ) DVA